Expert’s comment concerning Grand Rounds case entitled “Spontaneous and idiopathic chronic spinal epidural hematoma: two case reports and review of the literature” (by S. Sarubbo, F. Garofano, G. Maida, E. Fainardi, E. Granieri, M. A. Cavallo)

Excerpt

Epidural hematoma is generally contained in the “less common” spectrum of intraspinal, extradural lesions, particularly in the absence of sentinel events such as surgical manipulation or trauma [1]. As noted in this review, epidural hematomas can be divided into three categories: secondary, spontaneous and idiopathic-determined by our ability to demonstrate a cause for the bleeding. As in most instances where spinal pathologies have intracranial parallels, the relatively small size of the region of interest and the tendency of many hemorrhagic vascular abnormalities to obscure or obliterate themselves in the act of bleeding undoubtedly contribute the probably undeserved prominence of the “idiopathic” category of epidural hematomas in the spinal canal. As such, consideration should be given to detailed investigations such as screening for uncommon coagulation abnormalities and repeated imaging in a delayed fashion for such lesions where the etiology remains unclear. Given the potential contribution of increased venous pressure within Batson’s plexus to such hemorrhages, careful attention should be given to ruling out anatomically remote arteriovenous shunts such as due to AVMs. …